SHARDA SCHOOL OF NURSING SCIENCE AND RESEARCH

SHARDA UNIVERSITY

SUBJECT: NURSING FOUNDATION

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TITLE PAGE

NAME OF THE STUDENT TEACHER:

NAME OF THE SUPERVISOR:

NAME OF THE SUBJECT: MEDICAL SURGICAL NURSING

NAME OF THE TOPIC: ANEMIA

TIME:

DURATION:

DATE:

VENUE: M.SC. NURSING CLASS ROOM 203

GROUP: M.Sc. NURSING, (MSN) 1ST YR, SNSR

MEDIA OF TEACHING: LECTURE, DISCUSSION

AV AIDS: PPT, WHITE BOARD, METACARD, CUT PIECE AND CHART

OBJECTIVES

GENERAL OBJECTIVES: At the end of the class, students will be able to explain about Anemia.

Specific Objective: At the end of this class,students will be able:

 To introduce the anemia.

 To define anemia
 To enlist the causes of anemia
 To state the risk factor of anemia
 To explain the classification of anemia
 To explain the types of anemia
 To describe the pathophysiology of anemia
 To enumerate the clinical manifestation of anemia
 To enlist the diagnostic evaluation of anemia
 To list the complication of anemia
 To explain the medical management of anemia.
 To describe the nursing management of the anemia
 To enumerate anemic diet
 To summarize
Time Specific Content Teaching Teaching AV Evaluation
Objective Activities Method Aids
2 min  Introducing the
topic
2 min To introduce Introduction: Student teacher Lecture PPT What is
anemia It is a major killer disease in India. Statistics reveal that every will introduce cum anemia?
second Indian women is anemic. One in every five menstrual anemia discussion
deaths is directly due to anemia.

It affects both the adults and children of both sexes, although

pregnancy women and adolescent girls are most susceptible
and most affected by the disease.

Anemia affects an estimated 24.8 percent of the world's

population.Pre-school children have the highest risk, with an
estimated 47 percent developing anemia, globally. More than
400 types of Anemia have been identified.
2 min To define Definition: Student teacher Lecture PPT What is the
anemia It is a condition in which the hemoglobin concentration is will define definition of
lowers the normal. As a result, the amount of oxygen anemia anemia?
delivered to body tissue is diminished.

Normal Value: Men 13.5-16.5gm/100ml Female

12-15gm/100ml Normal value of Hb
2 min To enlist the Causes of Anemia: Student teacher Lecture PPT What are the
causes of The body needs red blood cells to survive. They carry will enlist the cum causes of
anemia hemoglobin, a complex protein that contains iron molecules. causes of discussion anemia?
These molecules carry oxygen from the lungs to the rest of anemia
the body. The causes of anemia are as follows:
 Increase requirements
 Increase blood loss
  Decrease intake
 Decrease absorption
3mins To state the risk Risk Factor for Anemia: Student teacher Lecture PPT What are the
factor for Anemia can occur in people of all ages and race, both males will state the cum risk factors of
anemia and females. However, certain factors increase the risk. risk factors for discussion anemia?
These include: anemia
 menstruation
 pregnancy and childbirth
 being born preterm, being aged 1 to 2 years
 having a diet that is low in vitamins, mineral, and iron
 losing blood from surgery or injury
 long-term or serious illness, such as AIDs, diabetes,
kidney disease, cancer, rheumatoid arthritis, heart failure,
and liver disease
 family history of inherited anemia
 intestinal disorders-affects absorption of nutrients
 Low socio economic status
 Multiparty

10 To explain the Classification of Anemia: Student teacher Lecture PPT What are the
mins classifications A) On the basis of cause will explain the cum classification
of anemia • Bleeding (blood loss) classification of discussion of anemia?
• Hypoproliferative anemia (inadequate production of normal anemia
blood cells)
• Hemolytic (destruction of blood cells)

1) Anemia caused by blood loss

The most common type of anemia iron deficiency anemia
often falls into this category. It is caused by a shortage of
iron, most often through blood loss. When the body loses
blood, it reacts by pulling in water from tissues outside the
bloodstream in an attempt to keep the blood vessels filled.
This additional water dilutes the blood. As a result, the red
 blood cells are diluted.
Blood loss can be acute and rapid or chronic.
Rapid blood loss can include surgery, childbirth, trauma, or a
ruptured blood vessel.
Chronic blood loss is more common in cases of anemia. It can
result from a stomach ulcer, cancer, or tumor.
 Causes of anemia due to blood loss include:gastrointestinal
conditions
 use of non-steroidal anti-inflammatory drugs (NSAIDs),
such as aspirin and ibuprofen
 menstrual bleeding

2) Anemia caused by decreased or faulty red blood cell

production
Bone marrow is a soft, spongy tissue found in the center of
bones. It is essential for the creation of red blood cells. Bone
marrow produces stem cells, which develop into red blood
cells, white blood cells, and platelets.
A number of diseases can affect bone marrow, including
leukemia, where too many abnormal white blood cells are
produced. This disrupts normal production of red blood cells.
Other anemia caused by decreased or faulty red blood cells
include:
 Sickle cell anemia: Red blood cells are misshapen and
break down abnormally quickly. The crescent-shaped blood
cells can also get stuck in smaller blood vessels, causing
pain.
 Iron-deficiency anemia: Too few red blood cells are
produced because not enough iron is present in the body.
This can be because of a poor diet, menstruation, frequent
blood donation, endurance training, certain digestive
conditions, such as Crohn's disease, surgical removal of
part of the gut, and some foods.
 Bone marrow and stem cell problems: Aplastic anemia,
for example, occurs when few or no stem cells are present.
Thalassemia occurs when red blood cells cannot grow and
mature properly.
 Vitamin deficiency anemia: Vitamin B-12 and folate are
both essential for the production of red blood cells. If either
is deficient, red blood cell production will be too low.
Examples include megaloblastic anemia and pernicious
anemia.

3) Anemia caused by the destruction of red blood cells

Red blood cells typically have a life span of 120 days in the
bloodstream, but they can be destroyed or removed
beforehand.One type of anemia that falls into this category is
autoimmune hemolytic anemia, where the body's immune
system mistakenly identifies its own red blood cells as a
foreign substance and attacks them.
Excessive hemolysis (red blood cell breakdown) can occur for
many reasons, including:
 Infections, severe hypertension
 certain drugs, for example, some antibiotics
 snake or spider venom
 toxins produced through kidney or liver disease
 an autoimmune attack because of hemolytic disease
 vascular grafts and prosthetic heart valves
 clotting disorders, enlargement of the spleen

B) On the basis of morphology:

• Microcytic – If the cells are smaller than normal, e.g. iron
deficiency anemia, anemia of chronic disease, thalassemia.
• Normocytic – if cells are in normal size, e.g.- acute blood
loss, anemia of chronic disease, hemolytic anemia, Aplastic
anemia.
 • Macrocytic - if they are larger than normal, e.g.-
Megaloblastic anemia
6 min To describe the Types of Anemia: Student teacher Lecture PPT What are the
types of anemia 1. Iron deficiency anemia – it is caused by a lack of iron. It will describe cum types of
develop when body store of iron drops too low to support the types of discussion anemia?
normal RBCs production. Women are at risk, for anemia
menstrual blood flow and growing fetus.

2. Anemia of chronic disease – it is a chronic disease of

inflammation, infection and malignancy cause this type
of anemia.

3. Thalassemia – it is a genetic disorder that is characterized

by abnormal formation of hemoglobin it results in
inadequate oxygen transport and destruction of RBCs
which leads to anemia.

4. Aplastic anemia – it is a rare disease in which the bone

marrow and hematopoietic stem cells that are damaged
leads to pancytopenia (deficiency of all three cellular
components of the blood such as red cells, white cells,
and platelets).

5. Megaloblastic or folic acid deficiency anemia - in this

condition the bone marrow usually produce large,
abnormal and immature RBCs. It results from inhibition
of DNA synthesis during RBCs production so it leads to
continuing cell growth without division.

6. Pernicious anemia - it occurs when the intestine can’t

properly absorb vitamin B12.

7. Sickle cell anemia – it is characterized by RBC that

 assume the abnormal, rigid, sickle shape. It results from
the presence of mutated form of Hb.
9 min To describe the PATHOPHYSIOLOGY: Student teacher Lecture PPT What is the
patho- Pathophysiology of Thalasemia: will describe cum patho-
physiology of Due to etiological factors patho- discussion physiology of
anemia physiology of anemia?
Disturbance of ratio between the alpha and beta globin chain anemia
synthesis

Then decrease production of one or more globin chains

formation of abnormal Hb structure

Ineffective erytheropoiesis

Excessive RBC destruction

Iron overload

Extramedullary hematopoiesis

Thalassemia

Pathophysiology of Iron deficiency anemia:

 There are three pathogenic factors:
 Impaired Hb synthesis due to reduced iron supply
 Generalized defect in cellularproliferation
 Survival of erythroid precursor and erythrocytes is
reduced
When tresferrin saturation < 15%, marrow supply of iron
reduced and is inadequate to meet basal requirement for Hb
production.
 Erythrocyte protoporphyrin raised
  Each RBC contain less Hb so microcytic and
hypochromic
Pathophysiology of Sickle cell anemia:
 Hypoxia & dehydration
 Sickling
 Membrane distortion
 RBC Stickiness

Haemolysis&Vaso-occlusion

Pathophysiology of Aplastic Anemia

Stem Cell

Genetically altered stem cells due to environmental insult

(Viruses, Drugs, etc.)

Express new antigens Reduced proliferative &

differentiative capacity
IFNy
TNF
T-cell responseMarrow aplasia

Pathophysiology of pernicious anemia:

Normal gastric mucosa secretes a substance called intrinsic
factor necessary for absorption of vit.B12 in ileum.

If defect exists in mucosa intrinsic factor may not be secreted

Orally ingested vitamin B12 is not absorbed.

Vitamin B12 is necessary for the normal DNA synthesis in

maturing RBCs.
 Pernicious anemia
3 min To enumerate Symptoms Student teacher Lecture PPT What are the
the symptoms In mild cases, there may be few or no symptoms. The most will enumerate cum symptoms of
of anemia common symptom of all types of anemia is a feeling of the symptoms discussion anemia?
fatigue and a lack of energy. of anemia
Other common symptoms may include:
 Paleness of skin
 Fast or irregular heartbeat, Chest pain
 Shortness of breath
 Headache, Dizziness, insomnia
 Easy fatigue
 Loss of energy
 Hypotension
 Difficulty in concentration
 Leg cramps
 Changes in stool color
 Spleenomegaly

Some forms of anemia can have specific symptoms:

 Aplastic anemia: fever, frequent infections, and skin
rashes
 Folic acid deficiency anemia: irritability, diarrhea,
and a smooth tongue
 Hemolytic anemia: jaundice, dark colored urine,
fever, and abdominal pains
 Sickle cell anemia: painful swelling of the feet and
hands, fatigue, and jaundice

1 min To enlist the Diagnosis: Student teacher Lecture PPT What are the
diagnostic  History will enlist the cum diagnostic
procedure of • Physical examination diagnostic discussion procedure of
anemia • Complete blood count procedure of anemia?
 • Others :Stool,Hb test, Iron, Folate, Vitamin b12, bilirubin. anemia
Hb electrophoresis, Reticulocyte count, Bone marrow biopsy.
2 min To list the Complication of Anemia: Student teacher Lecture PPT What are the
complications • Hypoxia will list the cum complications
of anemia • Severe fatigue complications discussion of anemia?
• Physical & mental growth retardation of anemia
• Heart problem: irregular heart rate, heart enlargement, heart
failure
 Neurologic damage
• Pregnancy complication – premature birth
• Death
6 min To explain the Medical Management: Student teacher Lecture PPT What are the
medical There is a range of treatments for anemia. They all aim to will explain the cum medical
management of increase the red blood cell count. This, in turn, increases the medical discussion management
anemia amount of oxygen the blood carries. Treatment will depend management of of anemia?
on the type and cause of anemia. anemia

 Blood transfusion – specially RBCs transfusion.

 Iron deficiency anemia: Iron supplements(Oral ferrous
sulfate  Iron dextran or iron sorbitex parenteral therapy)
or dietary changes(Oral or parenteral iron therapy. If the
condition is due to loss of blood, the bleeding must be
found and stopped.
 Pernicious anemia: Parenteral replacement with
hydroxycobalamine or cyanocobalamine is necessary by
IM injection every month.
 Folic acid deficiency anemia:
The goal is to identify and treat the cause of the folate
deficiency.
 You may receive folic acid supplements by mouth or
through a vein. If you have low folate levels because of
a problem with your intestines, you may need treatment
for the rest of your life.
  Diet changes can help boost your folate level. Eat more
green, leafy vegetables and citrus fruits.
 Aplastic anemia: The patient will receive blood, Platelet
and RBCS transfusions or bone marrow transplants.
Immunosuppressive treatment and androgens to stimulate
bone marrow regeneration.
 Thalassemia: Treatment includes folic acid
supplementation, spleenectomy and blood transfusions and
bone marrow transplants.
 Anemia of chronic disease: This is anemia associated
with a serious, chronic underlying condition. There are no
specific treatments, and the focus is on the underlying
condition.
 Sickle cell anemia: Treatment includes oxygen therapy,
pain relief, spleenectomy and intravenous fluids. There
may also be antibiotics, folic acid supplements, and blood
transfusions. A cancer drug known as Droxia or Hydrea is
also used.
 Hemolytic anemia: Patients should avoid medication that
may make it worse and they may receive
immunosuppressant drugs and treatment for infections.
Plasmapheresis, or blood-filtering, might be necessary in
some cases.

5 min To describe the Nursing Management Student teacher Lecture PPT What are the
nursing 1. Nursing diagnosis: Imbalanced nutrition less then body will describe cum nursing
management of requirement related to inadequate intake of essential the nursing discussion management
anemia nutrients as evidenced by skin integrity, color & body management of of anemia?
weight. anemia
•Goals: Improve nutrition level
• Intervention:
 A healthy diet should be encouraged.
 Avoid alcoholic beverages.
 Dietary teaching session should be individualized
including culture aspect related to food preference and
food preparation.
2. Nursing diagnosis: activity intolerance related to low
level of Hb in body as evidenced by the weakness, fatigue
and malaise.
• Goal: Improve the activity intolerance.
• Intervention:
 Assist the patient to prioritize the Activities and a
establish balance between the activity and rest that is
realistic and feasible from the patient perspectives.
 Patient with chronic anemia need to maintain some
physical activity and exercise to prevent the
deconditioning that results from the inactivity.

3. Nursing diagnosis: ineffective tissue perfusion related to

less blood volume as evidenced by skin color (pallor).
• Goal: Improve tissue perfusion.
• Intervention:
• The nurse monitors the vital sign closely.
• lost volume replaced with blood transfusion or IV fluids.
• Supplemental oxygen may be necessary but it is rarely
needed on a long term basis.
• Other medication such as antihypertensive agent may be
needed to be adjusted.
4. Nursing diagnosis – ineffective tissue perfusion related to
less blood volume as evidenced by skin color (pallor).
• Goal: Improve tissue perfusion.
• Intervention:
 Monitor the vital sign closely.
 Lost volume replaced with blood transfusion or IV fluids.
 Supplemental oxygen may be necessary but it is rarely
needed on a long term basis.
  Other medication such as antihypertensive agent may be
needed to be adjusted.
5 min To enumerate Anemic Diet Student teacher Lecture PPT What comes
anemic diet If the anemia is caused by nutritional deficiencies, a change to will enumerate cum under anemic
an iron-rich diet can help alleviate the symptoms. The anemic diet discussion diet?
following foods are high in iron:
 iron-fortified cereals and breads
 dark-green leafy vegetables, for instance, curly kale
and watercress
 pulses and beans
 brown rice
 white and red meats
 nuts and seeds
 fish
 tofu
 eggs
 dried fruits, including apricots, raisins, and prunes
2 min Summary Summarization:
Student teacher
will define, list
out the causes,
symptoms,
explain the
patho-
physiology,
types,
classifications,
complications,
medical
management,
nursing
management of
anemia and
 anemic diet.

Conclusion: It is a condition in which the hemoglobin concentration is lowers the normal. As a result, the amount of oxygen delivered
to body tissue is diminished.

Recapitalization:

What is the definition of anemia?

What are the causes of anemia?

What are the types of anemia?

References

• Joyce M. Black Jane Hokanson” Medical Surgical Nursing”.7th edition, Elsevier publication, volume 1,page no. 619-651

• Suddarth’s&Burnner” Text book of Medical Surgical Nursing”.twelfths edition, Wolters publication, Page no. 910-927

• Saunders ”comprehensive review for the NCLEX RN examination”.fifth edition, elsevier publication, page no. 520-522

Internet:

https://www.medicalnewstoday.com/articles/158800.php

https://www.slideshare.net/HARINAGAR49/anemia-77665937